Contributions to the treatment of dermatologic manifestations of Lyme borreliosis

Lyme borreliosis was identified in Czechoslovakia for the first time in 1985. Since then, more cases have gradually been identified. Since 1989, about 1,500 patients per ten million inhabitants have been reported every year. Having summarized the results of the therapy of 371 patients with dermatologic manifestations of lyme borreliosis (erythema migrans in 315, borrelial lymphocytoma in fifteen, and acrodermatitis chronica atrophicans in forty-one) we present the antibiotic regimens used by Czechoslovak dermatologists in clinical practice.

Cutaneous bacterial infections. How to manage primary, secondary, and tertiary lesions

Lesions of the threefold spectrum of bacterial infections usually can be diagnosed on the basis of the clinical picture, but sometimes laboratory studies and a therapeutic trial may be needed for confirmation. Fortunately, a number of effective antimicrobial agents and adjunctive measures are available for treatment.

Pathology of the mucous coat of trout skin during an erosive bacterial dermatitis: a technical advance in mucous coat stabilization for ultrastructural examination

A fixation regime which combined cryopreservation, freeze drying and vapour fixation with osmium tetroxide, was found to preserve the mucous coat of trout skin for ambient temperature scanning electron microscopy. The regime was used to study changes to the mucous coat of trout skin during a spontaneous outbreak of "columnaris" disease--a common dermatitis of commercial salmonids associated with the bacterial pathogen Cytophaga columnaris. Infected and damaged regions of skin were covered by a mucous coat which differed from that which covered adjacent unaffected areas. In unaffected areas, the mucous coat topography was smooth and relatively featureless. In contrast, the mucous coat which covered damaged areas was fissured, cratered and contained exfoliated epithelial cells. Nevertheless, this study showed that even sites of extensive dermal ulceration, in which mucous cells had been destroyed, retained a partial mucous coat. This suggests that mucus, after secretion, flows over the skin surface, rather than functioning only near the site of production. Because of the various protective functions attributed to the mucous coat, its partial presence over areas of skin damage would contribute to defence against secondary pathogens and to the prevention of excess movement of ions and water at these sites. The technical development in mucous stabilization, described in this paper, will provide a means for examining morphological changes to the mucous coat of fish skin in response to a range of stimuli in future studies.

Localized cutaneous nocardiosis in Japan. A new case

We report a case of localized cutaneous nocardiosis due to Nocardia asteroides, appearing on the anterior surface of the right forearm of a 29-year-old woman. Examination of the skin revealed a firm subcutaneous nodule measuring 32 x 20 mm and accompanied with a small ulcer. The histology of the lesion showed granulomatous changes interspersed with large numbers of polymorphonuclear leukocytes. On Gram staining, a few bacillary bodies were found scattered through the lesion, but no grains were detected. The classification of the clinical types of cutaneous nocardiosis is discussed, and the Japanese literature on localized cutaneous nocardiosis is examined.

Chronic verrucous varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome (AIDS). Histologic and molecular biologic findings

Verrucous skin lesions have been attributed to various herpes viruses in immunosuppressed patients, including those with human immunodeficiency virus infection (HIV). We examined such lesions from six HIV-infected patients to determine the range of microscopic findings present and to establish which herpesviruses were present. Verrucous epidermal hyperplasia, pseudocarcinomatous hyperplasia, and massive hyperkeratosis correlate with the warty clinical appearance of the lesions. Herpetic cytopathic changes, including multinucleated epidermal giant cells, steel-gray nuclei, necrotic acantholytic keratinocytes, and Cowdry type A nuclear inclusions were seen most prominently in the dells between papillations and in adnexal epithelium. In two cases, increased numbers of spindled cells were seen in the dermis. Immunoperoxidase staining with anti-type IV collagen antibodies demonstrated that these findings were not those of Kaposi's sarcoma, but represent a fibrotic reaction to the infection. Viral cultures of four of the cases demonstrated the presence of varicella-zoster virus, whose presence was detected by the polymerase chain reaction in paraffin-embedded lesional tissue from all six cases. Polymerase chain reaction did not show the presence of cytomegalovirus, herpes simplex, Epstein-Barr, or human papillomavirus. We conclude that these unusual verrucous lesions are a chronic manifestation of herpes zoster infection and that the reported presence of other agents in such lesions is probably coincidental.

Dermatopathologic findings in patients infected with HIV

Several inflammatory, infectious, and neoplastic conditions in HIV-infected patients are distinctive or require a biopsy for diagnosis. Some differ subtly from similar conditions seen in noninfected patients. The exanthem of acute HIV infection cannot be diagnosed specifically on biopsy as its histologic appearance is similar to that of other viral exanthemata. A condition that closely resembles seborrheic dermatitis occurs in HIV-infected patients. Plasma cells, necrotic keratinocytes, and leukocytoclasis may be present, in contrast to findings in sporadic seborrheic dermatitis. Psoriasis and Reiter's disease also occur in HIV-infected patients and can be specifically diagnosed as such. The category "psoriasiform dermatitis of AIDS" thus seems to include several distinct entities and not to be a single disease. Bacillary angiomatosis is a treatable infection caused by a rickettsialike organism similar to Rochalimaea quintana, the agent of trench fever. Cutaneous lesions are characterized by lobules of capillaries with protuberant endothelial cells, neutrophils and their debris, and purplish-staining clumps of organisms, which can be demonstrated with silver stains or electron microscopy. An unusual reaction to atypical mycobacterial infection, in which spindle-shaped macrophages are seen, resembles histoid leprosy. Viral skin diseases that may challenge the dermatopathologist include unusual verrucous reactions to chronic varicella-zoster infection and flat warts caused by the human papillomavirus associated with epidermodysplasia verruciformis. Keratinocytes with foamy basophilic cytoplasm may be a marker for one of these viruses, human papillomavirus type 5. Neoplastic complications of HIV disease include Kaposi's sarcoma and mycosis fungoides. The earliest lesions of the patch stage of Kaposi's sarcoma show a slightly increased number of cells with small ovoid nuclei around preexistent structures, accompanied, in some cases, by sparse infiltrates of lymphocytes and plasma cells. Staining with antisera to type IV collagen may highlight the vascular spaces in these early lesions. Later lesions that resemble hemangiomas may also prove challenging and require level sections to demonstrate the presence of spindle cells and eosinophilic globules. Although HIV is cytotoxic to helper T cells, neoplastic proliferations of them may be seen in HIV-infected patients. These cases of mycosis fungoides do not seem to differ from sporadically occurring ones and occur in patients who seem not to be infected by HTLV-I.

Cutaneous anthrax--a report of ten cases

The clinical features of ten cases of cutaneous anthrax are reported. Six males and four females were affected. Their ages ranged from one and a half year to sixty years. The average incubation period was 8 days. Fever and headache were common systemic manifestations. Pruritus and ulcer with formation of black eschar were typical features. The patients were treated with penicillins and chloramphenicol. There was no mortality. Possible human-to-human spread in a patient is discussed.

Glomerular localization of platelet factor 4 in streptococcal nephritis

Since platelet factor 4 (PF4), a cationic (pI 7.6) platelet secretory protein, binds avidly to glomerular polyanions both in vitro and in vivo, and is implicated in neutrophil chemotaxis, we studied by indirect immunofluorescence microscopy the presence of PF4 deposits in glomeruli of patients with poststreptococcal nephritis (APSGN). Goat antihuman PF4 serum was used as primary antibody and fluorescein-conjugated IgG fraction of rabbit antigoat IgG as second antibody. Controls consisted of nonimmune goat serum or anti-PF4 serum preabsorbed with human PF4, as primary antibodies. Glomerular deposits of PF4 were demonstrated in renal tissues obtained by biopsy in 14 of 20 patients studied; the deposits were particularly intense in 9 patients. PF4 was bound to the mesangium and to the capillary walls. There was a significant positive correlation between intraglomerular deposits of PF4 and the levels of proteinuria (p = 0.024). These findings provide further evidence for a role of platelets in the pathogenesis of APSGN and suggest that PF4 may contribute to alter the glomerular permeability in this disease.

Evaluation of human papillomavirus type 5 on frozen sections of multiple lesions from transplant recipients with in situ hybridization and non-isotopic probes

Transplant recipients are at high risk to develop multiple cutaneous lesions after grafting. The frequency of the potentially oncogenic human papillomavirus (HPV) type 5 DNA was evaluated in cutaneous lesions taken from sun-exposed areas in transplant recipients (92 lesions and 5 samples from normal skin) and compared with a nontransplanted population (22 lesions and 7 samples from normal skin) using in situ hybridization and biotinylated probes to HPV types 1, 2, 5, 16 and 18. HPV type 5 DNA was identified in 8/92 cutaneous lesions of transplanted recipients: 3 warts, 1 case of seborrheic keratosis, 2 actinic keratoses and 2 keratoacanthomas. HPV type 5 DNA was not detected in 27 malignant tumors (8 basal cell carcinomas and 19 squamous cell carcinomas) from transplant recipients. HPV DNA type 5 was detected in only 1 case of squamous cell carcinoma from the general population. The presence of HPV DNA 5 was confirmed with Southern blotting in 2 out of 6 cases from transplant recipients. The reaction was negative with the squamous cell carcinoma from nontransplant recipients. These data indicate that the presence of HPV DNA type 5 is not very frequent; it can be detected with in situ hybridization and nonisotopic probe, which is easier to handle than Southern blot.

Chronic varicella zoster in a child infected with human immunodeficiency virus: case report and review of the literature

Chronic zoster represents an infrequent presentation of varicella zoster virus infection. It is observed with increased frequency in patients infected with human immunodeficiency virus, especially when their lymphocyte counts are depressed. We report a child infected with human immunodeficiency virus who showed a long-standing cutaneous zoster lesion and was treated for a prolonged period of time with acyclovir. The occurrence of resistance to acyclovir by varicella zoster virus was suspected based on the clinical picture. The clinical and laboratory features of this case and a review of the literature are presented.

Summer and skin

Some skin problems either occur exclusively in summer, or are exacerbated by heat and humidity. The more common of these conditions are discussed briefly in this article.

[Spotted fever: isolation of Rickettsia from a skin biopsy sample]

A 2 years old child living in an area of the State of São Paulo, known in the past as endemic for rickettsiosis developed clinical evidences of spotted fever after a tick bite. Rickettsiae were isolated from guinea pigs inoculated with a skin homogenate. In sera tested by indirect immunofluorescence with Rickettsia rickettsii standard antigen, IgG specific antibody titers raised from 1:512 in the first sample to 1:2048 in the third one; IgM specific antibody titer was 1:128 in the three samples. Also positive were sera obtained from the inoculated guinea pigs. In the last 20 years no other case of rickettsial spotted fever has been confirmed by isolation of the agent in Brasil. To our knowledge, there are no previous reports of isolation of Rickettsiae through inoculation of skin biopsy homogenates.

An unusual presentation of fixed cutaneous sporotrichosis: a case report and review of the literature

Sporotrichosis is extremely rare in infants. This report describes an 84-day-old girl with fixed cutaneous sporotrichosis, presumably transmitted by a cat. A rapid, complete response to a low dose of oral potassium iodide therapy was attained. To our knowledge, this is the youngest reported patient with sporotrichosis, as well as the lowest effective daily dose of potassium iodide.

Aggressive periodontal destruction and herpes zoster in a suspected AIDS patient

An unusual case of spontaneous and rapidly destructive lesions involving the periodontal structures is described in a 54 year old, bi-sexual patients suspected of having AIDS. Concomitant with the periodontal breakdown, the patient developed a severe case of Herpes Zoster involving the area of the face innervated by the 5th cranial nerve. The dermal lesions involved the face, nose, eyes and scalp. Similar lesions were noted on the gingival and palatal mucosa on the same side of the jaw as the skin lesions. The differences between this type of periodontal destruction and more conventional forms of periodontitis are discussed.

Histopathology and immunopathology of skin biopsy specimens in Mediterranean spotted fever

Histology of skin lesions and demonstration in them of Rickettsia conorii by direct immunofluorescence test (DIF) are presented in 13 patients with Mediterranean spotted fever (MSF). The lymphohistiocytic vasculitis which dominated the picture is not specific, however, it could be suggestive for the diagnosis of rickettsiosis. By DIF we demonstrated rickettsial coccobacillary forms in all the patients: in 12 macular lesions and in one "tache noire". The diagnosis was also confirmed by indirect immunofluorescence test in each case. DIF test was shown to be sensitive, specific and reliable in early diagnosis of MSF.

Human orf and milkers' nodule: a clinicopathologic study

We report the clinical and histopathologic features of 17 patients with orf or milkers' nodule infection. The majority were male, 12 to 65 years of age, and gave a history of contact with farm animals. Most lesions affected the hands or arms, ranged in size from 1 to 3 cm, and occurred on average 3 weeks after presumed exposure. On low-power examination the epidermis showed endophytic strandlike proliferations and the dermal papillae were distended by intense edema. There was massive capillary proliferation and dilation and a dense inflammatory infiltrate. High-power examination revealed epidermal viral cytopathic changes with inclusion bodies, clumping of keratohyalin, and cytoplasmic vacuolation that had a distinctive "spongiform" appearance within follicular structures. We conclude that orf and milkers' nodule infection have distinctive histopathologic features, and, in contrast to some previous reports, viral changes may frequently be found.

Summer lesion syndrome in salmon: a retrospective study

The factors involved in the development of 'summer lesion syndrome' were studied on 13 salmon farms based in the coastal waters of the west of Ireland. The primary causal factor in the development of the syndrome appeared to be overexposure to solar ultraviolet radiation. The pathology of the condition is described, the predisposing and reinforcing factors are considered and a hypothesis for the cause of the syndrome is proposed.

Concurrent epidermal involvement of cytomegalovirus and herpes simplex virus in two HIV-infected patients. Military Medical Consortium for Applied Retroviral Research (MMCARR)

Although cytomegalovirus has previously been reported in cutaneous lesions of patients infected with the human immunodeficiency virus, these reports are not common despite the prevalence of this infection and the significant pathologic characteristics that it induces in HIV disease. Rare reports of possible epidermal involvement by cytomegalovirus have never been fully documented and have been believed by some to represent epidermal involvement by varicella-zoster and/or herpes simplex infections, with dermal involvement of cytomegalovirus. We present two cases of concurrent epidermal involvement by cytomegalovirus and herpes simplex virus documented by immunohistochemical studies and DNA hybridization studies and correlate this with the distinctive morphologic features seen in these two viral infections on routine staining.

Lymphoid proliferation and lymphoma associated with human retroviruses (HTLV and HIV)

There are rapidly increasing opportunities for dermatologists to see patients suffering from retrovirus infections. The HTLV-I was the first class of human oncogenic retrovirus that was found in cultured cells of a patient with skin manifestations similar or identical to those of CTCL (MF). It was soon recognized as the agent causing ATLL. The skin manifestations, histopathology, and immunophenotypes of ATLL share many similarities with MF and SS. Both HTLV-I and HIV-I (HTLV-III) cause immunodeficiency with an increased susceptibility to opportunistic infections. Persistent generalized lymphadenopathies are the initial manifestations of most of the HIV infections. The incidence of lymphoid malignancies is expected to become much higher as the life span of AIDS patients is prolonged. They can have both B-cell and T-cell non-Hodgkin lymphomas, although the incidence of the latter (B-cell lymphoma) is still much higher than that of the former. All human retroviruses are transmitted in similar ways.

Cutaneous Histoplasma capsulatum in a nonimmunocompromised patient with previously treated cutaneous Mycobacterium kansasii

This report describes a black woman with a history of cutaneous Mycobacterium kansasii responsive to antituberculous drugs. A culture several years later of cutaneous lesions was also positive for Histoplasma capsulatum. Both cutaneous diseases are rare and most often occur in immunocompromised hosts. There is no known association between these two diseases. This patient may have an as-yet unidentified immunodeficiency that predisposes her to these rare infections. Her case emphasizes the importance of repeat biopsy for atypical skin lesions.

Inflammatory responses to cryptococcosis in congenitally athymic mice

Histopathology revealed that nu/nu mice developed both acute and chronic inflammatory responses following infection with Cryptococcus neoformans. In comparison to inflammatory responses in nu/+ mice, the responses in nu/nu mice were delayed, less intense, contained predominantly more polymorphonuclear leukocytes (PMNs) than macrophages (M phi s), and did not develop into granulomas. In addition, nu/nu mice developed cryptococcal skin lesions demonstrating that C. neoformans is dermatotropic in a T-cell deficient host. Quantitative culturing of infected organs confirmed that delayed and incomplete inflammatory responses observed in nu/nu mice correlated with their enhanced susceptibility to C. neoformans.

Cutaneous lesions of histoplasmosis with transepidermal elimination in a patient with acquired immunodeficiency syndrome

Histoplasma capsulatum is a dimorphic pathogenic fungus that produces a variety of self-limiting disease syndromes in healthy persons, but commonly disseminates in immunocompromised hosts. Although histoplasmosis has been recently described in patients with acquired immunodeficiency syndrome, it is an uncommon finding, occurring in fewer than 0.5 percent of patients with acquired immunodeficiency syndrome. We are reporting a second case of disseminated histoplasmosis presenting as keratotic papules with transepidermal elimination of Histoplasma capsulatum. Our case demonstrates the importance of including histoplasmosis in the differential diagnosis of keratotic papules occurring in patients with acquired immunodeficiency syndrome.

Cutaneous herpes simplex virus infections

Affecting millions of Americans each year, herpes simplex virus infections are among the most common human viral infections. Many clinical forms exist, depending on the site of infection and the patient's age and immune status. Clinical evaluation and laboratory studies help establish the diagnosis. Acyclovir is the drug most often used to treat herpes simplex virus infections, although newer agents, such as phosphonoformate trisodium, may be required for acyclovir-resistant infections.

Swimming pool granuloma associated with erythema nodosum

Erythema nodosum was the presenting feature of swimming pool granuloma in a twelve-year-old girl. This entity should be added to the list of disorders associated with erythema nodosum.

Diagnosis of cutaneous cytomegalovirus infection: a review and report of a case

Cytomegalovirus infections are a major source of morbidity and mortality in immunocompromised patients. We report a case of cutaneous cytomegalovirus in a patient with the acquired immunodeficiency syndrome, in which routine light microscopy was suggestive but not diagnostic of cytomegalovirus. Immunohistochemical studies of the specimen for cytomegalovirus antigens revealed numerous intracytoplasmic and intranuclear viral inclusions. This case illustrates the utility of immunoperoxidase techniques to diagnose cytomegalovirus infection of the skin rapidly. Immunohistochemistry, DNA in situ hybridization, and polymerase chain reaction have been added to the more routine methods of viral culture and light microscopy to diagnose cytomegalovirus. In this report we review the cases of cutaneous cytomegalovirus in the literature and the laboratory detection methods available to establish this diagnosis.

Inverted follicular keratosis and papillomavirus infection

This report describes a case of inverted follicular keratosis in a keratotic nodule found on the thigh of a 58-year-old man. The upper surface of the nodule was papillary, while the lateral aspect was smooth with columnar structures. Histologically, the lesion exhibited primarily exophytic growth, although there was some endophytic growth. There were multiple closely approximated columnar solid tumor nests. Many of these columnar tumor nests had a central funnel-shaped plug of dense parakeratotic keratinous material. The tumor nests were composed of peripheral smaller basaloid cells and central squamoid cells forming squamous eddies. Inflammatory lymphocytic cell infiltration and lytic change were found mainly at the base of the tumor. Several hair follicles transversed the tumor. Ballooning alteration of granular cells and vacuolated keratinocytes, especially within areas of hypergranulosis, were observed in each of the columnar tumor nests. Some cells with ballooning alteration were recognized by papillomavirus common antibody. Ultrastructurally, vacuolated keratinocytes exhibited cytoplasmic vacuoles containing keratohyaline composite granules. Compound structures of membrane-coating granules, which have been associated with outer root sheath keratinization, were noted. The case therefore represents an inverted follicular keratosis manifesting as a distinct hair follicle tumor related to prior infection by papillomavirus.

Tissue effects of and host response to human papillomavirus infection

Human papillomaviruses are a heterogeneous group of DNA tumor viruses associated with hyperplastic (warts, condylomata), dysplastic (CIN and VIN), and malignant lesions (carcinomas) of squamous epithelium. Each HPV type is preferentially associated with specific clinical lesions and has an anatomic site preference for either cutaneous or mucosal squamous epithelium. Infection appears to begin in the basal cells. Early gene expression is associated with acanthosis, and late gene expression is associated with appearance of structural antigens and virions in nuclei of cells of the granular layer, usually koilocytotic cells. Malignant transformation of warts and papillomas appears to be related to a variety of factors: (1) infection by certain HPV types (HPV-5, HPV-8, HPV-16, HPV-18, HPV-31); (2) decreased cellular immunity to HPV-associated antigens; and (3) interaction with cofactors such as other microorganisms or sunlight. Spontaneous regression or successful treatment of the benign lesions appears to depend on either naturally acquired or iatrogenically related stimulation of HPV type-specific immunity. The humoral antibody response to HPV particles may be important in preventing infection. In contrast, the local events surrounding regression of warts and condylomata are primarily associated with specific cell-mediated immunity. Local cell-mediated immune responses, particularly cell-associated soluble mediators and stationary macrophage-like cells, may be especially important in the host's immune response to mucosal infections.

Persistent cutaneous ulcers associated with feline herpesvirus type 1 infection in a cheetah

Persistent cutaneous ulcers developed in a female cheetah cub after an episode of rhinotracheitis. When they were 3 weeks old, the cub and a male littermate developed mucopurulent oculonasal discharge consistent with feline herpesvirus type 1 infection (feline viral rhinotracheitis). The male cub was weaned and its lesions resolved. The female cub remained with the dam until the cub was 3 months old, at which time plaque-like lesions developed on the eye margins and muzzle. These plaques regressed over the next month and were replaced with cutaneous ulcers ranging from 1 to 10 mm in diameter. Feline herpesvirus type 1 was isolated from biopsy specimens collected from the ulcers. Cutaneous ulcers are uncommon manifestations of feline herpesvirus infections and have not been reported in other exotic fields. A proposed susceptibility to viral infections related to low genetic diversity has been proposed in cheetahs, and may be involved in the pathogenesis of persistent herpetic ulcers.

Cutaneous botryomycosis

We report four cases of cutaneous botryomycosis. The predisposing factors included alcoholism, diabetes, and trauma. Clinically, the patients had nodules, suppurative plaques, or ulcers. In two cases, Staphylococcus aureus was cultured. In one case Neisseria species was cultured and in another a coagulase-negative Staphylococcus and Corynebacterium species were the only organism cultured. All patients responded to systemic antibiotic therapy.

Vibrio vulnificus septicemia in Korea: clinical and epidemiologic findings in seventy patients

We studied the clinical characteristics and the epidemiology of primary septicemia associated with Vibrio vulnificus in 70 patients. All patients came from the western and southern coastal areas of Korea. Most cases (96%) occurred during the summer months, in men (96%), and in persons 40 or more years of age (90%). The illness of 46 patients (66%) began with septicemia, often within 2 days of the consumption of raw seafood. Forty-seven patients (67%) had preexisting hepatic disease, and 49 (70%) had a history of alcoholism. Of the 70 patients, 45 (79%) died. The cutaneous lesions that were present on admission in 64 patients (91%) appeared on the legs in 51 of the cases. V. vulnificus was isolated from the blood of 65 patients tested and from the skin lesions of 51 of 55 patients tested. The histopathologic findings differed according to the clinical stage of lesions. Because V. vulnificus septicemia is a highly fatal disease, persons with liver disease or alcoholism should avoid eating or handling raw seafood.

Necrotizing lesions of soft tissues: a review

Necrotizing lesions of the soft tissues are grave entities not infrequently seen in daily surgical practice. They may occur with epidemic proportions after natural disasters, representing a serious challenge to the surgeon since they are characteristically associated with high mortality rates unless an early diagnosis is made and prompt aggressive surgical management is initiated. Necrotizing fasciitis is the currently accepted generic term to encompass into a single category the diverse syndromes of progressive gangrenous infections of the skin and subcutaneous tissues. Necrotizing fasciitis must be viewed as a clinical entity rather than a specific type of infection: it is a clinical infection most commonly caused by a mixed aerobic/anaerobic synergistic polymicrobial combination. Zygomycetes may appear as major causal organisms (mucormycosis) and they should be actively searched for. Initial diagnosis of necrotizing fasciitis is established through the characteristic physical signs. Gram stain, and, in some doubtful cases, through frozen-section tissue biopsy. Aggressive and urgent radical debridement is the key to survival, combined with wide-spectrum antibiotic therapy.

Experimental cutaneous protothecosis in mice: epithelioid cell granuloma formation

Prototheca wickerhamii, isolated from skin biopsy specimens of a patient with cutaneous protothecosis, were cultured in Sabouraud's medium and inoculated in the skin of 8 ICR albino mice and 3 BALB/c mice. Only in 3 ICR albino mice and 3 BALB/c mice were organisms found in skin tissue, as confirmed by identification of organisms by staining with periodic acid-Schiff (PAS) stain and culture. Histologic findings from affected nodular skin lesions indicated epithelioid cell granuloma and histiocytic cell infiltrates in the dermis and subcutaneous tissue.